A vacancy exists for a Case Manager Specialised Units (FTC) for 6 months, based at Life St. Dominic’s Hospital, reporting to Patricia Barlow, Patient Services Manager. The successful candidate will be responsible for the management of the financial and clinical administrative risks pertaining to patients in specialised units – Intensive care units and high care units.

Critical Outputs
Ensuring operational excellence by

Conducting ward rounds and ensuring the accurate complete collection of clinic data from patient files and liaisons with nursing staff and attending clinicians
Updating accurate clinical information to justify length of stay and level of care to medical funds of specialised unit cases and where operationally required general ward cases.
Updating and providing the necessary information to funders regarding high value items, limited benefits and protocols as defined by managed care organizations
Communicating funder requirements / responses to attending clinicians and patients where necessary, and ensuring compliance with industry standards
Ensuring effective management of real time and manual messaging, including requests, responses, rejections and submissions.
Ensuring the accurate submission of accounts to funders.
Complying with governance and risk management requirements by ensuring adherence to patient services policies and procedures
Ensuring compliance to service level agreements with internal and external stakeholders
Ensuring effective management of revenue by

Ensuring the accurate and complete coding of patient accounts
Ensuring the correct application and correct interpretation of funder RSRT contracts and FFS claims
Reporting RSRT risks identified to the relevant manager
Ensuring effective management of quality outputs by

Adhering to patient services escalation processes and customer services standards
Investigating and reporting published alerts incidents and agreeing upon appropriate action with internal and external stakeholders
Ensuring effective management of relationships with internal/external stakeholders by

Building and maintaining relationships with internal stakeholders
Providing and facilitating training regarding RSRT contracts
Providing feedback and information regarding concerns or issues raised by external stakeholders
Providing feedback on external stakeholders impacting on the efficiency and effectiveness of the case management process
Escalating doctor non-compliance in terms of RSRT framework to RSRT meetings

Requirements

Diploma or degree in Nursing, Physiotherapy, Clinical Associates, Paramedics as Critical Care Assistants or Emergency Care Practitioners or any other qualification that covers Anatomy, Physiology, Pathophysiology and Microbiology as foundational courses.
Current registration with the relevant professional / regulatory body
Knowledge of hospital patient services and 3 years’ experience in case management
Knowledge and understanding of CPT & ICD coding
Knowledge of Funder contracts, scheme rules, exclusions and benefits
Understanding of private hospital industry and practices
Computer proficiency experience including proven leadership, change and people management

Competencies

Problem-solving, analysis and judgement
Resilience
Engaging diversity
Verbal & written communication and presentation
Influencing
Drive & energy
Excellence orientation
Ethical behaviour
Building relationships
Customer responsiveness
Organisational awareness
Leading my example (Key for Managers)
Motivating and developing people (Key for Managers)

Please send your resume/CV